AskMeDoctor! Season 2 Episode 1: Are Vaccines Necessary For Your Children?

Good news to you! Motherhood is back with our AskMeDoctor! series Season 2, with a new panel of experts to answer all your questions.

In this first episode, we have Dr Foo Chee Hoe, a paediatrician at Pantai Hospital Ampang and also at Dr Foo Child Specialist Clinic. 

We kick off our Season 2 with the importance of vaccination for your baby. This is one of the hottest issues in Malaysia. To ease your confusion and worries, read to know the answers regarding vaccination for your little one by Dr Foo.

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Q1: What is a vaccine?

Dr Foo: Vaccine is a biochemical substance that is created to be administered into the body usually via injection.

Sometimes it will be given via oral liquid, fed into the mouth with the purpose of triggering, stimulating an immune response in the human body so much that you will create antibodies specific to the targeted germs that you want to prevent against.

Usually, the germs that are targeted are usually life-threatening diseases. 

Q2: How many types of vaccines are there?

Dr Foo: If you want to divide them into methods of injection; most of the vaccines are injectables, either they are injected into the muscle, intramuscular vaccine, or if it is subcutaneous, we inject it into the fat tissue below the skin.

Rotavirus vaccine which is quite, I think quite popularly well known and accepted is the rotavirus vaccine that is given in the oral form, and there are still some places and in the past where poliovirus (vaccine) is given via oral method. 

Q3: What are the types of vaccines? 

Dr Foo: The better way to understand vaccines would be to divide them into the live vaccines.

• Live Vaccines

There are live but weakened (germ) vaccines which means the vaccines still contain a bit of life form of the bacteria or the virus but they are much weakened. They are weakened so it will not cause the disease but it will trigger an immune response. 

• The Inactivated Vaccines

The inactivated ones, they are not alive as they are inactivated. It is a kind of virus that you usually will see in the 5-in-1 vaccine, the pertussis vaccine and the diphtheria vaccine.

• Conjugated Vaccine

There are conjugated vaccine, recombined vaccine, that is the more modern one, it contains a specific part of the virus or bacteria but by their recombinant technology.

They conjugate the proteins that consist of the specific part of the germ which will then help the person to trigger a very specific response, a bit more long-lasting kind of response to the specific pathogen, the germ that will cause the disease. 

• Anti-Toxoid Vaccine Tetanus

It targets against the toxin, not really against the germ itself, not the structure of the germ, the bacteria or the virus but against the toxin that is produced by the bacteria so your body will be immune to the toxin.

Q4: How many vaccines are recommended for my child?

Dr Foo: Vaccines will be given almost every month. From birth onward, there is a list of compulsory vaccines which means it is already listed in the national vaccine schedule.

So, at birth, the child will be given their first dose of hepatitis-B and also BCG (Bacillus Calmette-Guérin) vaccine.

At one month of life, they will be given a second dose of hepatitis-B and also from second month onward, they will receive the 5-in-1 vaccine which is diphtheria (vaccine), pertussis vaccine, anti-tetanus vaccine, Haemophilus influenza (Hib vaccine), and poliovirus vaccine.

One month and second month onward: The first dose of hepatitis-B; BCG; the second dose of hepatitis-B;( 5-in-1 vaccine).

This is 5 types of germs combined into one. They will be given 3 times in your first year of life, 2nd month, 3rd month, and 5th month.

And then in your 6th month, you will be given your third dose of hepatitis-B as well. There are also additional vaccines which are very important for Paediatricians which is the pneumococcal vaccine.

• Pneumococcal Vaccine

So, the pneumococcal vaccine is also very important. It can be given as early as two months old, then you will be given every two monthly (once every two months/two every month).

So you can say that almost every month, there will be a set of vaccines to be given to the baby.

NOTE: This is based on the previous vaccination schedule before the Ministry of Health announced a new six-series vaccine schedule mid-Nov 2020. 

• Influenza Vaccine

Influenza vaccine is also good to take. It is additional and it is optional but we will highly recommend it above six months so you can take the vaccine.

Also, Hemema vaccine will be given from 9 months and another dose at 1 year old.

Q5: Why are vaccines important?

Dr Foo: Vaccines are important because it helps to achieve immunity against the germ, the pathogen that causes life-threatening diseases.

For example, we are now speaking in the era of the COVID-19 pandemic. Despite the lockdown and social distancing, we are unable to achieve total protection. We are not able to gain good control over this virus. It is an invisible enemy.

Vaccines are very important for us to really achieve herd immunity where we can count on the fact that everyone would be protected against the specific germ that can cause life-threatening disease because it can be given to a lot of people in a safe manner.

Most importantly, to achieve immunity without paying a high price.

Q6: Are there any side effects of vaccines?

Dr Foo: Vaccines can cause some side effects just like any other medicine. Usually, the side effects that we encounter would be:

• some low-grade fever
• painful red swelling at the site of injection

However, usually, they are nothing major which would resolve in a few days time.

Sometimes the vaccine may also cause an allergic reaction so you have a bit of redness, some rashes, hives, urticaria.

But then again, those will also resolve by itself but of course, we would look into allergy a bit more carefully and we need to determine whether it is suitable to be given the booster doses for the same vaccine. 

Please note that it is extremely rare to have very bad side effects. Usually, the ones that we encounter are these, fever, some swelling, some painful swelling.

• Febrile Seizure

Measles and chickenpox vaccines are live vaccines, so they may have a higher chance to cause a higher fever and result in a febrile seizure.

Some parents will think that MMR (Measle, Mumps, Rubella vaccine) can cause febrile seizure, but actually, there are many other causes of fever that can also result in exceptionally high fever and result in a febrile seizure. 

By the way, 5% of the normal population of any children between 6 months to 6 years old can have febrile seizure so the cause can be any viral infection, including the following immunisation.

So if you talk about measles, had there not been an MMR vaccine, you have a measles infection, everyone still gets measles, every child gets measles.

So the chances of getting febrile seizure as a result of the measle’s infection would be much higher than getting febrile seizure as a result of the measle’s vaccine.

We shouldn’t blame the vaccine because had there not been a vaccine, the hospital or parents will suffer more cases of febrile seizure. 

Q7: Are vaccine shots more dangerous compared to the disease that it is preventing?

Dr Foo: That is definitely, no. First of all, the doctor’s basic principle is, do not do any harm.

Why would we create a vaccine that may do more harm than the disease that we are trying to prevent? Actually, in this world, there are so many other viruses that we do not have a vaccine against.

The common cold virus, those rhinoviruses, which we would not have the desire to develop a vaccine because we are now targeting those that potentially are life-threatening such as diphtheria, pneumococcal infection, tuberculosis, meningococcal infection.

• Complications

These can really cause death and disability and severe complications. Vaccines at most usually are the very normal minor side effects that I mention just now.

Of course, I cannot say all vaccines are perfect and perfectly safe. Nothing adverse ever happened before but it is extremely rare. The chances would be one in a few hundred thousand or one in a million.

I would say that we will continue to monitor for any side effects that are previously not known. But those we have known about and which we have discovered, we would have published a long list of possible side effects but it is usually the for very extreme ones, rarely happen.

Sometimes when you talk about deaths and brain damage as an event following immunisation, it may be associated but it is not directly resulting from the vaccine itself.

Usually, it is because of human error, just coincidentally the person is also having an infection during the time of the vaccination and it can also be because the patients are not suitable to take the vaccine itself because there are some patients who are very immunocompromised. 

• AIDS or Cancer Patients

AIDS or cancer patients who are receiving chemotherapy, re now not qualified to take the vaccines which is why it is very important for healthy people to take their vaccines so that we do not infect them.

If we do not recognise that the patient is immunocompromised and they end up receiving the vaccine, that can be fatal. 

Q8: Are there any other methods to protect my babies from diseases instead of using vaccines?

Dr Foo: I would like to emphasise that we should not ask the word ‘instead.’ But you can say besides.

We cannot just be very complacent. The basic preventive methods include:

• Ensuring hand hygiene
• Distancing with people when you are not well 
• Disinfection
• Cleanliness

Those are very important because there are so many other viruses and common cold viruses and they are not protected by vaccines.

There is only a limited list of vaccines which are available to be given to children and usually, they are targeted against life-threatening infections like meningococcal, tuberculosis, pneumococcal vaccine, influenza and diphtheria. 

There are so many cough and cold viruses which vaccines would not protect against because usually, they are very mild. It is not cost-effective and not necessary to protect them against those common colds.

So, those hygiene methods that I mentioned about, the distancing, especially now with the COVID-19 pandemic, wearing a mask and making sure you are not in a very crowded place, especially if you are not well. 

Q9: Why do my children have to get vaccinated from a disease that I have never encountered before?

Dr Foo: There is a reason why we haven’t encountered those diseases before.

Even though we are the younger generation of paediatricians, we have not seen many cases of diphtheria and we have not seen polio which is not a bad thing at all.

It is actually very good that we do not encounter these diseases so frequently anymore. That is because of the success of the vaccination program.

• Poliovirus vaccine and Diphtheria vaccine

Without vaccines like poliovirus vaccine and diphtheria vaccine, then only we would keep on seeing them. Our hospitals would still be loaded with these infectious diseases but if we become complacent and we say “Ah, I do not encounter them anymore. No need lah,” then we would see a resurgence of such infection. 

We would see a repeat outbreak of these viruses that we are supposed to have achieved control against. A good example would be, measles vaccine. 

• Measles vaccine

Due to a lot of misunderstanding and misconception. The measles vaccine was avoided and you see a surge of measles infection in the United States and that alone had caused one hundred thousand deaths. 

So, to maintain control over these viruses and the herd immunity, parents must participate. It is a collective effort.

Once a sizable population who give up on vaccines, then, we would lose immunity and then we would encounter again all these very scary kinds of infections.

Can I give more than one vaccines on the same day?

I would suggest to consult your paediatrician. If your paediatrician says you can, please go ahead.

Parents play a vital role in their children’s health by getting them the vaccines that they need.

As we all know, there are also people that are against vaccination. So remember that vaccination can help your children from developing various life-threatening diseases.

No matter how, remember to seek advice from your doctor. Stay tuned with AskMeDoctor! series at Motherhood Story and don’t forget to catch up with a new episode every week at our Official Facebook page.